AEGiS-15IAC: Effect of syphilis on HIV-1 in patients taking antiretroviral therapy.

15th International AIDS Conference

Bangkok, Thailand - July 11-16, 2004

Effect of syphilis on HIV-1 in patients taking antiretroviral therapy.

Int Conf AIDS 2004 Jul 11-16; 15:(abstract no. A10420)

Koga I, Hosoya N, Goto M, Odawara T, Matsuda M, Sugiura W, Nakamura T, Iwamoto A
Division of Infectious Diseases, Advanced Clinical Research Center, Institute of Medical Science, University of Tokyo, Tokyo, Japan

BACKGROUND: A patient under successful HAART for 21 months experienced abrupt increase in the plasma viral load(VL) concurrently with secondary syphilis. He declared strict adherence to HAART. We wished to examine the role of syphilis on the plasma VL and acquisition of drug resistance mutations.

METHOD: Plasma HIV-1 VLs were measured with Amplicor®. We sequenced reverse transcriptase(RT), protease(PR) and env gene V3 region in the plasma HIV-1 or proviruses in peripheral blood mononuclear cells(PBMCs).

RESULT: To our surprise, the plasma viruses which broke through HAART in the index case had nine drug resistance mutations. We suspected a superinfection by a multi-drug resistant virus at first. However, the sequences indicated that the highly mutated virus evolved from his own virus. The patient had been referred to our hospital after introduction of HAART. The VL had been undetectable (<50 copies/ml) since he was reffered to our hospital until he presented with syphilis. Extensive cloning and sequencing of the proviruses in the frozen PBMCs revealed that his original virus contained AZT-fossil mutation T215D together with L210W. 30 percent of the clones(5/16) had M41L also. The results suggested us that he had been infected with AZT-resistant virus from the beginning. Syphilis infection might have driven the replication of HIV-1 and accelerated the acquisition of multiple drug resistances. We found additional 5 cases in our hospital who presented active syphilis while they were on antiretroviral therapy. Three of them had increase of HIV-1 VL when they presented with syphilis.

CONCLUSION: Syphilis infection is increasing among men who have sex with men (MSM) in large cities in North America. HIV-1 clinics in large cities have been seeing increasing number of patients with HIV-1 and syphilis co-infection especially among MSM. Our results suggest that acquisition of STIs might influence the outcome of HAART. Safer sex should be emphasized.

Keywords: AEGIS, HIV-1, Antiretroviral Therapy, Highly Active, Viral Load, HIV-1 Reverse Transcriptase, Zidovudine, Genes, env, Virus Replication, Mutation, RNA-Directed DNA Polymerase, North America, Humans, Male, therapy, genetics, virology, drug therapy

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A10420